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Treatment of arachnoid cysts always say depending on size

but no size is given...
Treatment of arachnoid cysts always say depending on size but no size is given. Is a 5 cm cyst possibly significant for seizures. This cyst displaces the "cerebellar tonsils and enlargesthe foramen Magendie". Thanks. (*****@******.***)
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Answered in 3 minutes by:
12/14/2011
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5,843
Experience: American Board Certified Neurologist, Internal Medicine
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Thanks for the question and I am very glad to help you with it. And also thanks for the waiting.

Only in few minutes from now I will follow up again and post here few questions to gather some additional information relevant to your question, and this will help me in finalizing my answer to your question.

Best regards

Dr Sathya.

(You may disregard the reply button to this post because I myself will follow up very soon. This post was sent to update you on the status of your question as mentioned above. Your question is very important to us and I really appreciate your waiting, thanks!)

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Thanks for the waiting.

Please provide me the following additional information to help with finalizing my answer to your question;

What are the current symptoms the patient is having?

Does the patient also have seizures?

If yes, then what kind of seizures and how often seizures occur?

Are patients symptoms stable or progressive?

Has the patient seen a neurologist or neurosurgeon?

Best regards

Dr Sathya.

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Customer reply replied 6 years ago

Person was found seizing and died.Autopsy showed aforementioned cyst. Is it large enough to have caused trouble? Never saw neurologist--this was first(and last)seizure

Thanks for all these additional information, and also thanks for the waiting.

I will right now go through this information and if still more info is needed then I will get back to you very soon and ask few additional questions; on the other hand if I feel I have obtained all the relevant information then I will first prepare a very detailed reply and then follow up with you at the earliest. And typing such detailed reply may take up to about 15 to 30 minutes depending upon the various number of points & amount of the details to be discussed.

Best regards,

Dr Sathya.

(You may disregard the reply button unless you have more questions before my next post; this message was sent to update you about the status of your question as above. And I will follow up at the earliest, thanks!)

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Once again thanks for all these additional information, and also thanks for the waiting.

First of all sorry to see that the person who had this cyst unfortunately was met with a fatal outcome.

Coming to the discussion;

There is no exact cut off value or cut off number that grades the arachnoid cyst size as small or large; rather whether the cyst is dangerous or not mainly depends upon the following 2 criteria;

1) Whether the cyst produces any major or severe symptoms or not

2) Whether the cyst is located in a crucial or sensitive area of the brain or not

A 5 cm size arachnoid cyst is generally considered as a large cyst considering that there is no much extra space inside the skull cavity. However it is not just the size, but the location of the cyst counts too. For example the person who you mentioned had it in a very crucial or sensitive area of the brain, that is in the lower brain stem/foramen magnum area and it was also displacing the cerebellar tonsils. These areas of the brain are very sensitive areas because vital centers like breathing, heart, blood pressure maintenance are all located in the lower brain stem area. When the cyst was compressing the cerebellear tonsils and displacing them it must have compressed the near by vital centers in the lower brain stem and caused these catastrophic fatal outcome, along with seizures.

Once again to your main question, yes the cyst you mentioned was a dangerous one since it was displacing the cerebellar tonsils and it must have been the cause for the fatal outcome in this patient along with the seizure. And about the size, there is no exact number or value which differentiates a benign from a serious cyst, however a 5 cm cyst is considered relatively large, and also factors like the location of the cyst and whether the cyst compresses the neighbor brain structures are important too; and in this case unfortunately it was located in a very sensitive area of the brain (lower brainstem area) and was most likely the culprit for the fatal outcome, due to its location in the very near vicinity of the vital centers that are located in the lower brainstem.

So if this cyst was identified before patient developed serious complications then it should have been treated at the earliest and such treatment (surgical removal or decompression of the cyst) would have probably prevented the complications. Of course an important point to make is this cyst was located in a very sensitive area and surgery in that area is very difficult because during surgery accidental damage to the brain stem vital centers can occur, however surgery should have been strongly considered for a 5 cm size arachnoid cyst that was compressing the cerebellar tonsils and was enlarging the foramen magnum (provided it was identified in time).

The above are my opinions regarding the management of the arachnoid cyst you described and please ask me if there are any further questions.

And once again thanks for the waiting!

Best regards,

Dr Sathya.

Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
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Satisfied Customers: 5,843
Experience: American Board Certified Neurologist, Internal Medicine
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